Does Medicare Cover Assisted Living?

Medicare provides coverage for different types of care and treatment such as skilled nursing facility stays and hospice care. Assisted living is somewhat similar to those kinds of care because of the similar services that they provide. So it would only be natural to ask if Medicare provides coverage for assisted living.

So a common question many people have is, “Does Medicare cover Assisted Living?” In this article, we answer that question in clear, plain English. You will also find the average costs of assisted living facilities and other helpful info.

Does Medicare Cover Assisted Living?

The short answer is no. In most cases, Medicare will not cover the cost of staying in an assisted living facility. That said, there may be some situations where you can get Medicare to cover these costs. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your assisted living facility.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for assisted living facility stays. Most of the time, Original Medicare does not provide coverage for custodial care. Custodial care is one of the services that is provided in an assisted living facility.

Even though Original Medicare does not provide coverage for assisted living facilities, there are some services it covers that are similar to assisted living facilities. One of those services is the skilled nursing facility (SNF) stays we mention above. Medicare Part A provides coverage for skilled nursing facilities.

For Medicare Part A to provide coverage for skilled nursing facilities, you’ll have to meet these conditions:

before being transferred to the SNF, the patient must first be in the hospital as an inpatient for three days
The patient must enter an SNF within 30 days after being discharged at the hospital
The SNF is a Medicare-approved facility
The patient will receive the same treatment he/she received in the hospital where he/she stayed.
The care should be given 24/7
5 days a week of therapy if it is necessary

Medicare Part A will also cover treatment and care for a medical condition that you develop during your stay at the skilled nursing facility.

Part C Coverage for Assisted Living

Just like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not provide coverage for assisted living facilities. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits.

However, coverage and out-of-pocket costs will vary depending on your plan. Medicare Advantage will only pay for the qualified medical care that you receive at the assisted living facility, but not the facility itself.

How Much Does Staying In An Assisted Living Facility Cost?

Staying in an assisted living facility may cost you from $3,000 to $6,000 per month. The total cost will depend on the care that you need during your stay.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.